SARA JAMBARSANG1, ALIREZA AKBARZADEH BAGHBAN*2, FARID ZAYERI3, SEYED SAEED HASHEMI NAZARI4, ALI NIKFARJAM5, ALI MORADI
1Department of Biostatistics, PhD candidate, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran -2PhD, Associate Professor, Proteomics Research Center, Department of Basic Sciences, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran - 3PhD, Associate professor, Proteomics Research Center and Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran - 4MD, MPH, PhD, Assistant professor of Epidemiology, Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran - 5MD-MPH, Deputy of health, Tehran University of medical sciences, Tehran, Iran - 6Asadabad Health and Treatment Network, Hamadan University of Medical Sciences, Hamadan, Iran
Background and purpose: Determination if treatment of HIV-infected patients subject to highly active antiretroviral therapy resulted in decreased viral replication and increased CD4 cell counts. The CD4 cell count at initiation was the dominant prognostic factor in patients starting HAART. The objective was to identify the effect of HAART on the transition rate between CD4 cell states based on a multi-state Markov model.
Methodology: This was an observational cohort study of 305 HIV-positive patients between 1999 and 2014 who were divided into two groups. One group of 179 patients had not received antiretroviral therapy and one group of 126 patients had received HAART. Both had been referred to the Iranian Research Center for HIV/AIDS.
Results: HIV-positive patients on HAART showed half the hazard of progression to death than those in the non-HAART group. The rate of recovery from state 2 of CD4 cells to state 1 in the HAART group was significantly greater than in the non-HAART group at HR = 2.5 (95% CI: 1.38, 4.70). The probability of recovery after 36 months from each state was estimated using Markov model.
Conclusion: It was found that the effect of HAART on the rate of recovery was significant only for patients that begin therapy from a CD4 value of >200 cells/ml. As treatment continued from three to five years, the probability of reconstitution of CD4 cells from <200 cells/ml to a normal nadir increased from 0.53 to 0.61. Our findings have important implications for clinical management and should be taken into account in future treatment guidelines.
HIV, highly active antiretroviral therapy, CD4 Lymphocyte Count, Markov model